Breast Health Update

What you need to know

By Kyle Roderick

In addition to intimately affecting a woman’s sexual identity, self-image, and sense of attractiveness, breast cancer also kills more females than any other cancer, save lung cancer. One hundred and ten American women die each day from the disease, and its incidence continues to rise. With a new case diagnosed every two minutes, what’s a woman to do?

“Get educated, live a low-risk lifestyle,” be pro-active, says James Sinclair, M.D., an oncologist affiliated with the Scripps Polster Breast Care Center at Scripps Clinic in La Jolla, California. Evelyn Lauder, founder of the Breast Cancer Research Foundation urges, “Never fear monthly self-exams or getting a mammogram. Go to your doctor and get information if you find a lump or suspect something.” If you have a family history of breast cancer, “Start getting annual mammograms at age forty,” Sinclair advises. If you have no family history of the disease, start getting tested annually once you turn fifty.

While breast cancer results from changes in the genes of breast cells, researchers have yet to pinpoint the precise cause of these genetic mutations. Statistics show that breast cancer develops more frequently in white women than in black or Asian women. According to Elizabeth Boham, M.D., of Canyon Ranch in Lenox, Massachusetts, “Family history, reproductive history, environmental exposure, and lifestyle are all factors in breast cancer risk.” Then again, “seventy percent of all breast cancer patients have no apparent risk factors in their background,” says Boham.

If you develop unusual symptoms in your breast, it’s best to see a specialist to get the most informed opinion. Potential symptoms of breast-cancer include nipple tenderness and/or discharge (fluid or blood) as well as a nipple that turns inward into the breast. Also look for a change in how the breast or nipple feels or looks; a change in the size or shape of the breast; a lump or thickening in or around the breast; or a bump or thickening in the underarm area.

While there is no sure-fire prevention strategy, there are several medically proven ways to lower your risk. “A mixture of daily aerobic exercise and resistance training, along with weight loss, offers significant preventive benefits,” Sinclair explains. “Make stress management part of your daily routine,” he urges. “Evidence-based medical research confirms that yoga, massage, and guided imagery can lower stress hormone production and thereby strengthen immunity.”

Another prevention tip is to reduce your toxic load by purifying your water with faucet filters and showerhead purifiers. “There’s good reason to believe, based on EPA water quality reports, that we need to be pro-active about purifying the water that we drink and bathe in,” says Sinclair.

There are other factors that increase a woman’s risk. Women who are exposed to radiation from frequent spinal X-rays, scoliosis, or Hodgkin’s disease treatment in their youth are at an elevated risk for developing breast cancer. “Being fifteen or more pounds overweight also increases breast cancer risk because fat cells create more “bad” estrogen,” he notes.

In addition, more and more studies show a link between alcohol and breast cancer and this tie “is more pronounced than with any other cancer,” says Sinclair. “One glass of wine, one bottle of beer, or one cocktail per day is preferable,” he says. “Anything above that increases breast cancer risk.”

The more circulating estrogen and the longer it’s moving around, the higher the risk of breast cancer. Conditions that influence this include first menstruation before age twelve, menstruation after fifty-five, giving birth for the first time after age thirty-five, remaining childless, and taking oral contraceptives for ten years or longer (although excess risk disappears within two years after stopping the pill).

In 2002, the Women’s Health Initiative (WHI) study (conducted by the National Institutes of Health) found an increased risk of breast cancer and heart disease among women who used synthetic progesterone, or progestin, taken in combination with estrogen.

“Women do need to be cautious about using progesterone cream or oral progesterone,” says Jane Guiltinan, N.D., clinical professor at Bastyr University and director of Bastyr Women’s Wellness Center in Seattle, Washington. She continues, “We don’t yet definitively know whether progesterone taken orally or used in cream is safe for women, period.”

According to Dale, “Many women are unaware that “natural” or “bio-identical” hormones are synthesized in a laboratory from soybeans or wild yams rather than in your body. These are as foreign to your system as any other HRT formula.” Furthermore, she adds, “Blood or hormone saliva tests indicate that “natural” hormones, including wild yam progesterone cream, routinely cause high hormone levels.”

Regarding the potential risks or benefits of so-called “natural” progesterone, “to make an assumption that because a product is natural [it] is completely safe is mistaken,” says Guiltinan.

The reason why so little is known about potential risks and benefits of natural hormones is that there have been no long-term studies of these. “There needs to be some long-term studies that would last for at least five years,” says Guiltinan, “such as the WHI trial of HRT which was cancelled prematurely after increased breast cancer risk and heart disease risk was correlated with HRT use.”

On the brighter side, early detection options abound. Optimal strategies include having regular mammograms. If something unusual appears, you may choose a stereotactic biopsy, a less-invasive alternative to surgery for breast tissue sampling. Stereotactic biopsies pinpoint calcifications for radiologists, who use a special needle to extract tiny core samples from suspected malignant tumors.

Magnetic resonance imaging (MRI) utilizes magnetic fields to create detailed computer images for organs and soft tissues. While an MRI can detect breast cancer earlier in those at high risk, MRI-guided biopsies may also delineate breast lesions. Physicians often order MRI’s for women diagnosed with breast cancer to define what stage their disease is in.

Another early detection breakthrough is ductal lavage, which can identify cancerous and precancerous cells in the breast’s milk ducts. Like the pap smear test for cervical cancer, ductal lavage is a non-surgical method for identifying abnormal cells before they become cancerous.

Ductal lavage involves two steps. First, a breast pump applies a mild suction to extract fluid from the nipple and a drop of fluid exits the duct opening. Although ductal fluid is not in itself a bad sign, ducts that have abnormal cells are more likely to produce fluid than ducts with normal tissue. Therefore, this process indicates which ducts to wash out.

In phase two, anesthetic is applied to the nipple. A flexible, hair-thin catheter is threaded through the nipple duct opening and into the fluid-producing duct. A salt water solution is pumped through the catheter into the duct and then extracted. The cells that are washed out in the fluid are collected and analyzed. Analysis will classify them as normal, atypical, or malignant. Though the relationship between atypical cells and breast cancer is unclear, atypical cells are considered early indicators of the disease. A woman who learns these cells are present through ductal lavage may decide to be more aggressive in her risk-reduction treatment, and a woman who discovers she is a high risk may opt for a voluntary partial or full mastectomy—and potentially save her life.

A few side effects may result from ductal lavage. While most women report that it is about as uncomfortable as a mammogram, some women may develop infections, which can be rapidly cured with antibiotics. And although it is not a substitute for mammography or clinical breast exam, ductal lavage empowers women who wish to be as pro-active as possible and make risk-reduction treatment decisions well before cancer develops. A simpler test for finding atypical breast cells is in the developmental pipeline, and many experts believe that major breakthroughs are coming soon. “I am completely optimistic that we will find a cure and be able to prevent breast cancer—and that this will happen within the next fifteen years or less,” says Lauder.